Why we need a book about pain
There has been a lot written about pain and its causes. This book is different. Let’s work together to explore how these ideas can be used in practice.
The scale of the problem is hard to comprehend
It’s estimated that more than 1.5 billion people live with chronic pain. This makes it one of the most prevalent, costly, and impactful health problems in the world.
The scale of the problem is hard to comprehend. Imagine 10 people in pain, then 100 and finally 1,000. Enough to fill an enormous theatre. Now imagine one-and-a-half million theatres just like that, all filled with people living with long term pain.
Beneath each number is a real person. An individual with a unique story where pain has grown to become a central part of life.
Pain is not just a feeling that is felt in the body. It’s like cellophane on a slide projector - it is a filter that tints every scene in life. Pain changes how we feel about ourselves and our bodies. It reduces our sense of what is possible, and causes echoes that ripple through our lives and the lives of those we love.
How can one approach work for all people with chronic pain?
Chronic pain is not one thing. It is a feeling or symptom that is associated with lots of different problems. Because of this, it is fair to ask: if pain is so varied, then how can a single approach be useful for all people?
While every person’s pain is unique, each situation shares common features. These include biological changes that relate to how pain is produced in the body, as well also phenomenological changes. These are the secondary effects of pain. The downstream consequences of living with pain, which occur in all people - just in different ways.
These common features interact in ways that contribute to pain. In many cases, these changes become a central force that drives the problem. By understanding these common features and studying their interactions, we can develop a personalised approach to treat pain that targets these multiple causes.
While each person’s pain is unique, this book provides an overarching model that works different types of chronic pain. It is not a standalone model, but a way of clarifying the problem and then prioritising action across multiple domains.
A primary problem with secondary effects
Our earlier work focused on helping people understand how pain works. The idea was the better information would lead to better choices, and better choices would lead to recovery. This book goes further. It offers an overarching model that you can use to take action. This begins by recognising that chronic pain is a problem of problems.
Chronic pain often starts with a particular event, which we call a primary problem. But over time, this issue creates other problems, which we call secondary effects. To the person in pain, this can feel like the original problem is getting worse. But in many cases, the reality is a layering of problems that reinforce the pain.
Imagine someone with a broken foot, which is their primary problem. As the body heals, secondary effects start to emerge. They lose strength and fitness due to inactivity. They may be unable to work, which adds stress. The injury leads to changes in multiple different body systems, but it also leads to changes outside of the self. The yard gets overgrown. Work pressures add up.
Pain shifts the status quo, leading to changes which have the effect of making pain worse.
Most treatments focus on identifying and removing the primary problem. If we remove the problem, the thinking goes, the pain will go. This makes sense for short-term pain, but chronic pain is different. Chronic pain is a problem of problems.
A short history of these ideas
In 1990, Ronald Melzack published a paper introducing the concept of the "neuromatrix." He was trying to explain why people with amputations often felt pain in limbs they no longer had.
His idea was revolutionary: pain isn’t simply felt in a body part, it’s generated by networks in the brain that represent the body. The pain feels local, but its origins are distributed throughout the brain.
This didn’t challenge the reality of pain. If it hurts, it’s pain - and if it is pain, it is real pain. But it did offer a new way of thinking.
Before this, pain was understood as a direct outcome of signals from the body. So much injury would produce so much pain. But the neuromatrix theory suggested that pain was more complicated than this. Pain was an action, an output - perhaps a decision - and it involved far more than just signals from the body’s tissues.
In the decades since, this theory has held up. Brain imaging studies show that pain involves widespread brain activity, including areas related to memory, vision, and decision making. Experiments using fake knives, coloured lights, and virtual reality have created real pain even when no damage has occurred in the body. The message is clear: pain is not a simple readout of tissue damage.
So, what is pain? Pain is protection.
Researchers now think of pain as a complex protective feeling which helps us to avoid danger, and allows the body to heal. Pain grabs our attention and it motivates action. In this way, pain functions much like fear. But unlike fear, pain has a location. It always feels like it hurts somewhere.
One of the remarkable things about pain is that our understanding of pain can literally change how it feels. But more importantly, our understanding of pain changes what we choose to do - and it is what we do about pain that drives recovery.
Chronic pain is a condition where pain stop us doing things that are necessary for recovery. Learning about pain helps to disrupt this cycle by offering new ways to respond to this familiar problem. This book will help you to understand the different ways that pain has impacted your life, and then develop a personalised plan to gradually move towards recovery.